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CASE 2

CASE 2 . 49 yo man HIV+ 1995 Bipolar 2 disorder highlighted by major depression with a few serious suicide attempts and necessitating multiple hospital admissions Smoker 2ppd x 35 yrs Lives in a supervised setting. CASE 2 . Tenofovir /FTC/RTV/ Darunavir x 4yrs Quetiapine /Venlafaxine

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CASE 2

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  1. CASE 2 • 49 yo man • HIV+ 1995 • Bipolar 2 disorder highlighted by major depression with a few serious suicide attempts and necessitating multiple hospital admissions • Smoker 2ppd x 35 yrs • Lives in a supervised setting

  2. CASE 2 Tenofovir/FTC/RTV/Darunavir x 4yrs Quetiapine/Venlafaxine • Remains adherent with both HIV and psychiatric meds • CD4 currently 380/28% and stable over 4 yrs • HIV viral load<40

  3. CASE 2 • Over last year unexplained weight loss of 23kg as documented in the chart…has become more precipitous over the last few months (5kg) • No associated constitutional symptoms • More fatigue/frequent napping noted • Appetite poor

  4. CASE 2 • No cough/soboe/hemoptysis/chest pain • No upper or lower GI symptoms • No pain/discomfort • No polyuria/polydypsia • No obvious worsening of psychiatric condition • No admitted illicit drug use WHAT WOULD YOU DO?

  5. CASE 2 Bloodwork CBC/lytes/creatinine/glucose/hba1c/calcium/liver enzymes/albumin/urinalysis/TSH/testosterone all normal Radiology CXR/Ultrasound abdo/Chest CT normal

  6. CASE 2 Temperature Chart normal WHAT DO YOU THINK? ANY OTHER INVESTIGATIONS TO ADD?

  7. CASE 2 OGD/Colonoscopy Negative for lesions/abnormalities Urinary Drug Screen Positive for Cannabinoids++

  8. CASE 2 Psychiatric opinion re: occult worsening depression Psychiatrist felt that excessive hidden marijuana use on a daily basis (>10gm/day) coupled with associated increasing paranoia/depression likely contributed to appetite/weight loss…marijuana confiscated and psychiatric meds readjusted

  9. CASE 2 • Fatigue improved • Less frequent napping • Appetite improving as now more awake for meals • weight up 2 kg over last month

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